Remdesivir for Covid-19: Dosages, Warnings, Adverse Effects

A short rundown: this is a highly potent medication, which is given to patients who are sick with Covid-19. It is suitable for patients with moderate to severe flow of the disease. This informative guide will shed more light on the potential of this medication and the way it affects the human body.

Remdesivir is known as an adenosine analog. It has been shown to be highly effective against SARS-CoV-2.1 in vitro. As per the research, Remdesivir therapy began immediately after inoculation in a rhesus macaque model. The treated creatures had lower viral levels in the lungs and less lung harm than the control ones.

Intravenous dosage is endorsed by the FDA for the treatment in hospitalized grown-up and pediatric patients (Note, it is referred to those matured ≥12 years and gauging ≥40 kg). It is additionally accessible through a FDA EUA for the treatment of COVID-19 in pediatric patients. It concerns those patients weighing 3.5 kg to <40 kg or matured <12 years and gauging ≥3.5 kg. Remdesivir ought to be managed in a clinic or a medical services setting that can give a comparative degree of care to a long term emergency clinic.

What about the Remdesivir efficacy regarding the Omicron variant? Although more testing is needed by now, the present data indicates that Veklury should be effective against the Omicron (B.1.1.529) strain. Veklury acts against the SARS-CoV-2 virus by interfering with virus replication. Besides, it works by suppressing viral reproduction within infected cells. Based on laboratory tests and the FDA understanding of how the medication works against the SARS-CoV-2 virus, it is likely to be active against SARS-CoV-2 variations that have spread widely to far, including the Omicron form. The modifications in the variations that have previously circulated (for instance, it concerns the Delta variant) or are now circulating (it, in turn, concerns the Omicron variant) are not likely to influence the section of the virus that medication targets.

The Mechanism of Action

Remdesivir is a generic preparation that derives from a brand called Veklury. It comes into two forms:

  1. Powder (100 mg);
  2. Solution (5 mg).

Both forms are meant for intravenous injections. In other words, the preparation should be injected into the vein. It is given in moderate and severe cases of Covid-19 to patients who are hospitalized. Remdesivir is officially approved by the FDA and is widely used thanks to its effectiveness.

As was said, its active substance effectively binds the viral RNA polymerase and does not allow the virus to develop in the system. Thanks to its inhibiting properties, the preparation shows great benefits for all hospitalized patients who are sick with coronavirus. Remdesivir has been studied in multiple clinical trials. It can be given to adult patients and the ones who are at least 12 years old.

How to Administer Remdesivir?

Remdesivir comes in two forms — solution and powder. Both forms are meant for direct injections in the vein. As it’s commonly prescribed for hospitalized patients, all the procedures will be taken by a doctor or a nurse. Before you get the first injection, you will have to pass blood tests and medical observations to be sure the active substance of the preparation is safe for you.

The procedure of infusion passes pretty slowly, but this measure is important to be sure it doesn’t damage your health. It takes from 30 to 120 minutes. However, you should not undergo it too frequently. Remdesivir is commonly administered once per 5–10 days. You will pass regular blood tests to define how the preparation affects your liver function.

What Is the Safest Dosage?

If you are prescribed Remdesivir, you will probably receive it in a hospital and so will be supervised by certified specialists. It is unlikely to get overdoses under such conditions. Your doctor will start the course of treatment from the lowest dosage. Commonly, it’s 100 mg for powder or 5 mg/ml for the solution. These dosages are enough for effective treatment.

What If I Miss My Common Dosage?

You will hardly miss your dosage if you are hospitalized because you will be cured and supervised by certified doctors and nurses. In case you are allowed to pass the treatment at home and complete all the injections yourself, you may possibly miss your dosage. In this case, you should not try to catch up with the missed injection. Otherwise, it may lead to severe adverse effects, which may threaten your life.

Are There Any Warnings and Contraindications of Remdesivir?

Such strong preparations as Remdesivir should be always taken with great caution and supervision of a specialist. The common warnings are as follows:

  • Liver function;
  • Kidney function.

Your health provider will surely take blood tests to define the current state of your liver and kidneys. You should obligatorily tell whether you ever had some diseases.

  • Pregnancy or planning pregnancy

In case you are pregnant or plan to get pregnant, make sure to notify your health provider. The initial clinical trials excluded pregnant women. Accordingly, it is not known how exactly would this preparation affect them. Nonetheless, there are certain cases when hospitalized pregnant women with severe symptoms of coronavirus were given Remdesivir in very low doses. The medical examination showed quite light adverse reactions and most of the withdraw very quickly.

As it’s unknown how the administration of Remdesivir will affect the development of the fetus, this preparation will be probably forbidden for treating if you plan pregnancy. If you feed the baby with breastmilk, this preparation may be likewise forbidden. Due to the lack of relevant data, it’s not known how Remdesivir will influence the newborn.

  • Severe allergenic reactions

There are some reports about severe allergenic reactions to Remdesivir. In case you have them, tell your doctor. You should never take it if you have serious allergies to any components of the preparation.

  • Age

This preparation is allowed to treat adult patients. As for children, it is approved for patients who are at least 12 years old. They should also weigh not less than 40 kilograms. Otherwise, the treatment with Remdesivir may be very dangerous for them.

Can It Induce Adverse Effects?

Remdesivir, as was previously said, is considered a very powerful preparation. It is administered right into the vein and so impacts the system very fast. Accordingly, it may induce certain health deviations, which are known as adverse effects.

It can produce gastrointestinal symptoms (such as nausea), raised transaminase values, an increase in prothrombin time without affecting the international normalized ratio, and hypersensitivity responses.

Prior to utilizing it, all patients ought to have liver capacity tests and prothrombin time tests led, and these tests should be rehashed as clinically important during treatment. Remdesivir ought to be halted assuming a patient’s alanine transaminase (ALT) level ascents past multiple times the maximum furthest reaches of ordinary, and it ought to be halted on the off chance that there is an expansion in ALT level as well as signs or side effects of liver irritation.

The most typical adverse effects observed by specialists are as follows:

  • Itching;
  • Increased and uncommon sweating;
  • Severe headaches;
  • Migraines;
  • The increased and sensitive pounding in the neck or ears;
  • Unstable heartbeat — too slow or too fast, as well as changeable rates;
  • Difficulty breathing;
  • Nausea and other issues with the digestive system;
  • Fever or chill;
  • The lightness of the head;
  • Increased sensitivity;
  • Uncommon perception of time and reality;
  • Issues with liver function.

Commonly, these adverse effects are of mild severity, and they pass pretty fast. In case you are treated at home, you are alone, and you feel any of these symptoms, do not delay and turn for emergency assistance as fast as possible. Don’t wait and hope that they will withdraw. They may worsen, and your health provider must know about them to treat you effectively and safely. If you are in a hospital, inform your doctor or nurse about any health deviations as soon as you feel them.

Considerations in Renal Insufficiency Patients

Every 100 mg powder vial of Remdesivir incorporates 3 g of sulfobutylether beta-cyclodextrin sodium (SBECD), and every 100 mg/20 mL vial of Remdesivir solution has 6 g of SBECD. SBECD is a material that is for the most part discharged through the kidneys. Contingent upon the formulation, a patient with the virus who takes a stacking portion of the dosage of 200 mg would get 6 g to 12 g of SBECD in result. This portion of SBECD is viewed as safe for individuals with ordinary renal capacity. SBECD aggregation in patients with renal inadequacy might cause liver and renal harmfulness. In people with renal disability, clinicians might decide to utilize the powder (which incorporates less SBECD). Adhere to the specialist’s proposals and guidelines as it were.

Children’s Considerations

Remdesivir is supported by the FDA for the treatment of the virus in hospitalized pediatric patients weighing 3.5 kg to 40 kg, or 12 years old and weighing 3.5 kg. Since these gatherings were not concentrated in clinical preliminaries, there is lacking information on the wellbeing and adequacy of utilizing it to treat COVID-19 in hospitalized pediatric patients matured 12 years or gauging 40 kg. The outcomes and short case series show that the medication was all around endured in kids who fulfilled the EUA prerequisites, in spite of the fact that information on untimely infants and youngsters are incredibly inadequate. A clinical preliminary is currently being directed to survey the pharmacokinetics of Remdesivir in youngsters. Adhere to the specialist’s proposals and guidelines as it were.

Are There Some Drug Interactions?

You should know that the combination of Remdesivir with some other medications may lead to unwanted consequences. Obligatorily inform your health provider if you take:

  • Chloroquine;
  • Hydroxychloroquine.

Both substances may weaken the efficacy of Remdesivir. Your doctor will decide either to increase the dosage or substitute any of those substances with other alternatives.

You should likewise tell your health provider about any other preparations and vitamins you are currently taking. They may interact with the preparation and lead to a decrease in its efficacy, as well as cause some health difficulties. Notwithstanding, there is no evidence that some other preparations or active substances may lead to such events.